7 total
Accident benefits claims dismissed entirely due to devastating surveillance evidence and unreliable, altered expert medical reports.
Three family members sought statutory accident benefits following a minor motor vehicle collision.
The arbitrator dismissed all claims for income replacement, caregiver, attendant care, housekeeping, and medical/rehabilitation benefits.
The arbitrator found the applicants were not credible, relying heavily on surveillance evidence that contradicted their reported disabilities.
Furthermore, the applicants' expert medical evidence was rejected due to altered clinical records, failure of experts to testify, and reliance on inaccurate self-reporting.
Claims for interest, a special award, and arbitration expenses were also dismissed.
Applicant deemed catastrophically impaired due to accident-caused mental and behavioural disorders resulting in marked impairment.
The applicant was injured in a motor vehicle accident and claimed she sustained a catastrophic impairment due to a mental or behavioural disorder.
The insurer argued the accident was minor and her impairments were pre-existing or caused by unrelated post-accident stressors.
Applying the three-stage process from Pastore, the arbitrator found that the accident materially contributed to the applicant's diagnosed mental and behavioural disorders, including major depressive disorder and pain disorder.
The arbitrator preferred the evidence of the applicant's experts and the insurer's occupational therapist over the insurer's psychiatrist, concluding the applicant suffered a marked impairment in the sphere of deterioration or decompensation in work or worklike settings.
The applicant was deemed catastrophically impaired.
Arbitrator awards ongoing income replacement and medical benefits, finding applicant completely disabled by chronic pain.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, housekeeping, and medical benefits.
The insurer terminated benefits, arguing the applicant could return to work and perform housekeeping.
The arbitrator found that the applicant suffered from chronic pain and psychological impairments caused by the accident, rendering her substantially and completely unable to engage in her pre-accident employment as a personal support worker or any suitable alternative employment.
The arbitrator awarded ongoing income replacement benefits, partial housekeeping benefits, and specific medical benefits, while dismissing other claims for lack of evidence.
Applicant awarded limited income replacement and housekeeping benefits for accident-related depression; other claims dismissed.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits, which the insurer denied.
The arbitrator found that the applicant suffered from accident-related depression that substantially disabled her from performing the essential tasks of her employment and housekeeping for a limited period.
The applicant was awarded income replacement and housekeeping benefits for the period from March to June 2005, along with interest.
Claims for ongoing income replacement, further medical benefits, examination expenses, and a special award were dismissed.
Arbitrator dismisses claims for further accident benefits, finding injuries fell within WAD II Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits.
The insurer terminated benefits, arguing the applicant's injuries fell within the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II (WAD II).
The arbitrator found that the applicant's impairments did not fall outside the WAD II Guideline, relying on independent assessments and surveillance evidence showing the applicant working and driving.
The arbitrator dismissed the claims for further medical treatment, income replacement, and housekeeping benefits, and ordered the applicant to repay an overpayment of income replacement benefits.
The claim for a special award was also dismissed as the insurer acted reasonably.
Applicant awarded income replacement and housekeeping benefits; Insurer's medical assessments rejected as flawed.
The Applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The Insurer terminated income replacement and housekeeping benefits based on insurer's examinations.
The arbitrator found the Applicant's evidence and her medical assessors' opinions credible, establishing that her physical and psychological impairments substantially prevented her from performing her pre-accident employment and housekeeping tasks.
The arbitrator rejected the Insurer's assessors' evidence as flawed and unpersuasive.
The Applicant was awarded income replacement and housekeeping benefits for the 104-week period, with interest.
Claims for post-104 week benefits were dismissed on a technical basis without prejudice.
The claim for a special award was dismissed as the Insurer's reliance on its assessors, though ultimately unsuccessful, was not unreasonable.
Application for income replacement benefits dismissed; applicant failed to prove substantial inability to perform employment tasks.
The applicant was injured in a rear-end motor vehicle collision and claimed income replacement benefits for fibromyalgia and psychological impairments.
The insurer terminated benefits after June 24, 2003.
The arbitrator found that the applicant's physical complaints were not objectively verifiable and preferred the insurer's psychological assessment, which concluded she was not substantially disabled from performing the essential tasks of her employment as a computer sales representative.
The application for arbitration was dismissed.
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